February 2014

February 23, 2014

If you like your health insurance plan, you can—wait a minute! Is there anyone out there that actually likes her health insurance? I’d like to meet her.

I mean I guess you could say I’ve always liked my health insurance “plan.” The problem is that it is delivered to me by an actual insurance company, and I’ve never met one of those that I like.

I think most people would have just gone ahead and paid the 19 bucks. But it’s the principle--and the fact that I’m two and one-half hours into this project already, I’m not giving up now. Furthermore, I think that’s exactly what they are counting on—in fact, I think that’s part of the business strategy of health insurance carriers. Most importantly, I pay Blue Shield $879 each month for health insurance—I think they can afford to pay $19 when they are supposed to be paying it. If only they didn’t make it so hard.

I’m not trying to single out Blue Shield. I used to have Aetna and had to fight for every dime with them too. That’s why I think it’s built into the business plan. In fact, it’s about the only business I can think of where the company providing services doesn’t have to treat you very well because they know there’s nothing you can do about it.

I was just at my bank last week getting a document notarized. They were so nice to me. We had an appointment, for which our banker was right on time. She smiled and made pleasant small talk. She even asked how my day was going so far. Unfortunately, I had just been on hold for an hour and 15 minutes with my insurance company over a stupid $19 dollar charge, so I think she’s sorry she asked. But she didn’t act sorry that she asked; she was really sympathetic. And she gave me a lollypop from the bowl sitting on her desk.

The bank knows I can go to any bank, so they try to be nice to me. Even when Doug calls our cable company to cancel HBO or Showtime because it’s too expensive, they try and do something nice for us, like letting us have it for another six months for only $10 a month. When we were in LA last weekend, all the people at the hotel were really nice, they even sent up a bottle of champagne to our room because they had it in their records that it was Doug’s birthday this month. They know there are many hotels we can choose from, so they need to actually do something to earn our business.

Not so with the insurance company. I’m not saying they are not nice, I’m just saying they really seem like they want to make it as hard as possible for me to receive the service for which I am paying them $879 a month. I didn’t mean to imply that the individual people are not being nice to me. It’s just that the institution itself seems to be against me.

Last month, Doug and I went to get our first-ever flu shots. By the way, we chose our health plan specifically because it was the only insurer whose network covered our wonderful, local medical facility. So we made a date of it, off to lunch and then to the clinic for shots. The experience did not disappoint. All of the parking right in front of the entrance says, “Reserved for Patients Only.” How about that for customer service?

Then when you get off the elevator, there are two smiling silver-haired volunteers to point you in the right direction. They warned us there would probably be a line for flu shots. But then there was no waiting at all!

I told the nurse I had never had a flu shot before, so she took a few minutes to tell me all about it and what I might experience in the next couple of days. All in all, it took about 10 minutes.

Unlike my old individual high-deductible policy, my brand new ACA-conforming policy now covers flu shots 100%. BUT ONLY IF YOU CALL THE INSURANCE COMPANY AND WAIT ON HOLD FOR AN HOUR AND FIFTEEN MINUTES. And even then, you still have to jump through a few more hoops.

When we got the bill for our two shots, the service to inject the shot for $31 was covered for each of us. But the $19 charge for the actual vaccine was applied to our deductible.

So I called our doctor’s office and they said they didn’t know why the vaccine wouldn’t be covered. It should be covered as preventive care just like the cost to inject it into our arms. The billing department referred me to my insurance company.

So then I waited on hold for an hour and 15 minutes. The agent, who was perfectly nice, looked into it and told me that the hospital coded the vaccine with the wrong billing code. He couldn’t tell me what the right code is but he said the provider would have to re-submit the claim with a “preventive diagnostic code.”

So I called my doctor’s office back and the billing gal said it was coded with a preventive code: V04.81. I’m not an expert in billing codes, so I just have to take her word for it. So I asked if she could tell me the code for the $31 charge that was covered, and guess what, it was V04.81!

So, when the Blue Shield agent called back to answer a question for my husband on his prescriptions charges, I hijacked the phone. I told him what the billing department told me, and he said they did not use the correct code, but “if my healthcare provider was unwilling to help me,” he would take matters into his own hands and override the charge.

Yesterday, the billing supervisor from my hospital called to say that she had also looked into the matter and the code was indeed already correct. She was going to “escalate” the matter and call the insurer directly to handle it for us. I’m happy to get out of the middle of this, since I wouldn’t know the difference between a billing code and a building code.

It just seems to me like at the very front end, my insurance company should have had some person that looks at the bills and says, “Oh my goodness, this is for a flu shot, and logic tells me that irrespective of the code that was used, I’m so smart that I know a vaccine and a shot go hand in hand, so we will cover the whole thing.”

And if an agent does have the ability to override a charge, shouldn’t they do it the first time I call, after I have waited on hold for an hour and 15 minutes, and before I talked to my doctor’s office two more times to find out that each one is pointing the finger at the other, neither responsible for the fact that I’m being billed $19 for something that should be covered by my $879 monthly premium?

Unfortunately, this experience is nothing new. Even when I had a great insurance plan at my former employer, I spent hours and hours on the phone fighting for them to cover the stuff they were supposed to cover. I suppose the good news is that now that I’m retired, I have the time to hold them accountable, even for a tiny $19 charge--something I simply would not have had the patience for when I was still working.

(For a really great read about trying to find out the price of a medical procedure in New York City read this Wall Street Journal article. Its author had to make 46 phone calls, was placed on hold 56 times, and wound up with 19 pages of typewritten notes—only to receive price quotes from 6 of the 10 hospitals she contacted.)